The frequency and financial burden of genetic disease in a pediatric hospital.

Medical charts from 1973 were reviewed from a general pediatric hospital whose admissions comprise 55% of those in the surrounding metropolitan area. The study population (4,115) was selected by using charts from January, March, May, July, September, and November of that year. The patients were categorized by diagnosis as to I) clearly genetic disorders, II) multifactorial disorders, III) developmental anomalies, IV) familial conditions, or V) nongenetic conditions. Of all admissions, 4.5% had genetic disorders (0.6% chromosmal, 1.2% autosomal dominant, 2.2% autosomal recessive, 0.5% X-linked recessive); 22.1% had multifactorial/polygenic conditions; 13.6% developmental anomalies; 13.2% familial disorders, and 46.6% nongenetic disorders. Patients with clearly genetic disorders (category I) were found to have had an average of 5.3 admissions as compared to 1.6 for patients with nongenetic conditions (category V). Of genetic patients (category I) 12.8% had more than 20 admissions as compared to only 1.2% for all patients studied (categories I-V). The length of hospitalization for genetic patients was 3.4 days as compared to 3.0 for all patients and 2.5 for nongenetic patients. Although the cost per day for genetic patients, exclusive of physicians' fees, was lower than for all patients, the total cost of hospitalization was the same (($450.98 as compared to $446.99 for all patients). Of all patients, 60.2% studied had third-party coverage, whereas only 43.8% of genetic patients did. Of all patients, 15.6% paid "out of their pockets" whereas 30.5% of genetic patients did. This study suggests that genetic patients have many more admissions which are slightly more expensive; that they stay longer in hospital; that they travel farther, and that their families end up paying the bill more often. No unusual differences in religion, race, age, or parents' marital status or occupation were found. It was remarkable that only one quarter of patients with genetic illness had received genetic counseling.